ANTHONY BUTLER: A new apartheid along the vaccination divide looms

Politicians must come on board the campaign using Limpopo as example

First published in BL PREMIUM 19 AUGUST 2021

The cabinet’s decision to approve the Covid-19 vaccination of 18-year-olds may have lifted the spirits of some younger people. In truth it is a sign of serious problems in the vaccination programme. Daily jabs have slumped far below the 300,000 per day target. More than half of over-60s have had full or partial vaccination, but the upward momentum has gone. As the government dropped through the age ranges, fresh take-up was disappointing.

The age-based approach was sensible, targeting those most likely to fall seriously ill and rectifying some of the inequality of access that typifies the allocation of scarce health resources. After all, this virus cannot be managed by granting privileged vaccine access to the rich, skilled workers or powerful public sector employees alone.

The poor, the less educated, those living in rural areas and the old need to be reached, not just for their personal wellbeing but because society as a whole depends on high and broad uptake to control the pandemic. Workplace vaccinations, in factories, offices, farms and mines, will drive up overall numbers, but considerations of age-based vulnerability and broader equity cannot be allowed to disappear.

Bringing down access ages boosts numbers for a week or two, but the government needs to do something new to achieve sustainable growth in the reach and efficacy of the programme. Private sector sites are attracting vaccine recipients, but their commitment in principle to free and open access for all needs to be translated into actual vaccinations in practice for non-medical aid scheme members.

Government officials have proved quite innovative when it comes to logistical and infrastructure challenges, and they may soon bring mobile vaccination units to social grant payment centres and local government offices. However, the key problems concern matters of public persuasion and trust, rather than those of delivery infrastructure.

As the wealthy, educated and powerful have become vaccinated, their perceptions of the unvaccinated have become increasingly hostile. Drawing their lessons from countries with very high levels of vaccine uptake in North America and the EU, they have begun to castigate the unvaccinated, describing them as self-excluding or as vaccine resisters.

The wealthy exhibit an alarming tendency to view their own good fortune as a well-deserved reward for intrinsic merit. Unless stopped some of them will try to secure legal mandates for new forms of social exclusion, including “vaccine passports” for shopping malls, restaurants, entertainment venues and transport systems. Such compulsion would not be welcome in a society already marked by widespread marginalisation, and it would further reduce the resource of public trust on which government will depend in the years ahead.

We can instead learn from the frontrunners in the persuasion stakes. Limpopo has apparently engaged traditional leaders, health practitioners and religious figures successfully, to sway public opinion in favour of vaccination. In urban areas, a wider range of sporting and cultural leaders and other role models can surely be brought on board. We still do not have clear and simple messages widely and repeatedly expressed in all of the country’s languages.

The Government Communications and Information Service has brought together civil society coalitions, communications professionals, business groups and labour organisations for weekly meetings in an attempt to forge a more successful vaccine communications strategy. This is a good start.

Given the unfortunate disappearance of the department of health’s ear-marked funding for this purpose, a modest fresh budget allocation would help. Equally important, however, is the fuller engagement of our most senior political leaders. They should apply themselves to the vaccine campaign as if it were an election campaign on which their personal political futures depended.

• Butler teaches public policy at the University of Cape Town.